Unusual study describes anatomical tip location for neonatal PICC

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The upper end of the pericardial reflection in neonates at autopsy lies below the middle of the 3rd thoracic vertebra. The tip of an upper inserted catheter should not extend below the level of the 3rd intercostal space” Eifinger et al (2016).

Abstract:

BACKGROUND: Central venous cannulation is widely used in neonatal critical care. Pericardial tamponade caused by vessel wall perforation can occur if the catheter tip induces extravasation at the level of the pericardium.

OBJECTIVE: To investigate the level of the superior pericardial reflection in stillborn babies.

MATERIALS AND METHODS: We dissected 20 bodies (11 female, mean gestational age 33 6/7 weeks, range 25-43 weeks), with careful opening of the thoracic area. After injecting contrast medium into the pericardial sac, we introduced a catheter through the right internal jugular vein. We then took radiographs to analyse the relationship between visual osseous landmarks and the pericardium.

RESULTS: Mean distance between the pericardial reflection at its upper end and the first thoracic vertebra was 1.3 cm (standard deviation [SD]: 0.3 cm) and did not extend over the 3rd intercostal space. The mean distance from the entry of the superior vena cava into the pericardial sac and the 1st thoracic vertebra was 2.3 cm (SD: 0.5).

CONCLUSION: The upper end of the pericardial reflection in neonates at autopsy lies below the middle of the 3rd thoracic vertebra. The tip of an upper inserted catheter should not extend below the level of the 3rd intercostal space.

Reference:

Eifinger, F., Vierzig, A., Roth, B., Scaal, M. and Koerber, F. (2016) The pericardial reflection and the tip of the central venous catheter – topographical analysis in stillborn babies. Pediatric Radiology. June 27th. [Epub ahead of print].

DOI: 10.1007/s00247-016-3659-y

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